Calcium as an Inopressor
OVERVIEW
- calcium has inotropic and vasopressor effects
- A direct relationship between ionized calcium levels in the blood and arterial pressure has been found in the critically ill
ADVANTAGES
- Positive inotropy without increase in HR
- increases MAP and LV stroke work index
- Reversal of myocardial depression caused by halogenated anaesthetics, hypocalcemia, calcium blocking drugs, post cardiopulmonary bypass, B blockers
- Reversal of cardiac toxicity of hyperkalemia
DISADVANTAGES
- In the setting of ischemia calcium administration may cause increased intracellular calcium accumulation and accelerate cell death
- Potential for ‘stone heart’ in patients on digoxin (extremely unlikely to be clinically significant)
- incompatibilities with other agents
- extravasation and tissue necrosis
- overshoot may result in symptomatic hypercalcaemia
EVIDENCE
- no high level evidence with patient-orientated outcomes
- based on laboratory studies, animal models and proof-of-concept studies in humans
References and Links
- CCC – Calcium metabolism
- CCC – Calcium basics
- CCC – Hypercalcaemia Overview
- CCC – Hypercalcaemia DDx
- CCC – Hypocalcaemia
- CCC – Hypocalcaemia DDx
- CCC – Calcium replacement (advantages/disadvantages)
- CCC – Calcium as an inopressor
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
